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Types of Health Insurance in the USA

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    Traditional

    • Traditional health insurance plans offer maximum flexibility because you can pick any doctor you like, and visit a specialist without the permission of your primary care physician, or PCP. A primary care physician is a doctor who provides your basic, everyday medical services. In a traditional plan, you have to spend a pre-determined amount, or "deductible," each year before your insurance coverage kicks in. Traditional plans tend to be more expensive than other types of plans.

    Health Maintenance Organization

    • HMO plans generally ask that you choose a primary care physician who is part of their network of physicians. Most HMOs require approval from your primary care physician before you can see a specialist, if you want the visit to that specialist to be covered by the insurance plan. HMOs don't have a pre-determined deductible amount; rather, you pay a "co-pay" for each treatment, which is a fixed dollar amount depending on the type of medical service you receive.

    Preferred Provider Organization

    • PPO plans are more flexible than HMO plans but not as flexible as traditional plans. In a PPO plan, you can choose to visit whatever health care providers you choose; however, certain doctors that are "in-network" will result in a lower co-pay amount. PPOs generally offer more coverage than HMO and traditional plans.

    Point of Service

    • POS plans are essentially a combination of HMO and PPO plans. You choose a primary care physician within the insurance company's network, and pay a small co-payment for treatments from this physician, similar to an HMO. However, in a POS plan you can also visit a health care provider that's out-of-network if you pay a percentage of the fee.

      There may be restrictions on the services you can receive outside the network with a POS plan. For example, prescription drugs, organ transplants, treatment for infertility, and mental health services may not be included.

    Exclusive Provider Organization

    • EPO plans are similar to both POS and HMO plans. In an EPO, you choose a primary care physician who's in the insurance company's network. However, out-of-network benefits are reduced, so there's a strong incentive to visit in-network physicians for treatments.

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